Localization of Pheochromocytomata by Caval Catheterization

Abstract

THE DIAGNOSIS of pheochromocytoma, once troublesome and frequently elusive, can now be easily established with precision and confidence in practically all cases. Current biochemical techniques for the determination of free uninary epinephrine and levarterenol (norepinephrine) excretion and their metabolites are responsible for this improvement. Comparable precision in the treatment of these chromaffin cell tumors is desirable and depends, in large part, on the accurate preoperative localization of the pheochromocytoma. Ectopic locations of pheochromocytomata in the chest, in the wall of the urinary bladder, and in the neck have all been reported.^1-5 Roentgenographic techniques, especially plain abdominal and chest films, excretory pyelograms with nephrotomography, presacral gas insufflation, and, most recently, selective arteriography have all been used in localizing such tumors. A significant proportion of pheochromocytoma patients may be too ill for such vigorous diagnostic measures and others have lesions which are not vascular enough or are too small to be